title: Palliative portal vein stent placement in malignant and symptomatic extrinsic portal vein stenosis or occlusion.
abstract: This article evaluates the results of portal vein (PV) stent placement in patients with malignant extrinsic lesions stenosing or obstructing the PV and causing symptomatic PV hypertension (PVHT). Fourteen patients with bile duct cancer (n = 7), pancreatic adenocarcinoma (n = 4), or another cancer (n = 3) underwent percutaneous transhepatic portal venous stent placement because of gastroesophageal or jejunal varices (n = 9), ascites (n = 7), and/or thrombocytopenia (n = 2). Concurrent tumoral obstruction of the main bile duct was treated via the transhepatic route in the same session in four patients. Changes in portal venous pressure, complications, stent patency, and survival were evaluated. Mean +/- standard deviation (SD) gradient of portal venous pressure decreased significantly immediately after stent placement from 11.2 mmHg +/- 4.6 to 1.1 mmHg +/- 1.0 (P < 0.00001). Three patients had minor complications, and one developed a liver abscess. During a mean +/- SD follow-up of 134.4 +/- 123.3 days, portal stents remained patent in 11 patients (78.6%); stent occlusion occurred in 3 patients, 2 of whom had undergone previous major hepatectomy. After stent placement, PVHT symptoms were relieved in four (57.1%) of seven patients who died (mean survival, 97 +/- 71.2 days), and relieved in six (85.7%) of seven patients still alive at the end of follow-up (mean follow-up, 171.7 +/- 153.5 days). Stent placement in the PV is feasible and relatively safe. It helped to relieve PVHT symptoms in a single session.
authors.affiliation: Department of Radiology and Interventional Radiology, Hôpital Archet, 151 route de Saint Antoine de Ginestière, 06202, Nice, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Novellas
authors.forename: Alban
authors.initials: A
authors.lastname: Denys
authors.forename: Pierre
authors.initials: P
authors.lastname: Bize
authors.forename: Philippe
authors.initials: P
authors.lastname: Brunner
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Motamedi
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Caroli
authors.forename: Patrick
authors.initials: P
authors.lastname: Chevallier
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000628:therapy*; D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000628:therapy*; D003251:Constriction, Pathologic / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000628:therapy*; D011169:Portal Vein; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome